Intermittent outpatient ultrafiltration for the treatment of severe refractory congestive heart failure

İleri evre kalp yetersizliği rehberi

“…Çalışma-larda DPD-APD konjesyonu gerilettiği, fonksiyonel kapasiteyi, yaşam kalitesini, 6 dakika yürüme mesafesini düzeldiği, hastanede kalış süresini ve hastaneye başvuru sıklığını azalttığı gösterilmiştir. [268][269][270][271] Dirençli konjesyonu olan hastalarda renal fonksiyonları bozulmamış olsa bile önemli ve mantıklı bir tedavi seçeneği olarak gözüken bu yöntemin daha geniş çalışmalara ile desteklenmeye ihtiyacı vardır. DPD-APD için özellikle bilinmek istenilenler; bu teknikten optimal faydalanacak hasta profili, optimal ultrafiltrasyon rejimi, osmotik ajan olarak glükoz yerine diğer ajanların (icodextrin) tercihi, uzun dönem sonuçları ve mortaliteye etkisidir.…”

Contemporary Trends in the Pharmacological and Extracorporeal Management of Heart Failure

“…Ultrafiltration has been used both in the in-hospital setting of acute decompensated HF and as an outpatient treatment of refractory HF. 54,55 The main rationale for its use in the acute setting would be rapid correction of fluid overload when standard management (eg, high-dose intravenous diuretics with or without inotrope agents) has been unsuccessful. 54 Of paramount importance in determining the role of extracorporeal ultrafiltration (with its attendant risks and expense) is whether the claim of its superiority over fluid removal by aggressive diuresis has a physiological basis.…”

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

“…This is not a widely used strategy and should only be used under the supervision of a physician with extensive expertise in its application. Several small studies have shown that ultrafiltration (slow continuous venovenous method or traditional dialysis) can be very effective in fluid removal and symptom improvement in a few highly selected patients with severe renal insufficiency and volume overload (104)(105)(106)(107)(108). These seem to be most effective when renal function is severe but stable, rather than acute.…”

“…This is in contrast to the acute intravenous administration of a betablocker to naïve patients in the acute myocardial infarction setting. There are no data regarding the use of beta blockade in cardiogenic shock because in most cases, clinicians will withhold in this setting (100,(106)(107)(108)(109)(110)(111)(112)(113)128).…”